© Georg Thieme Verlag KG Stuttgart · New York
Spontaneous decapitation of a small colorectal cancer: follow-up of the spontaneous course
24 October 2007 (online)
An 80-year-old woman with a history of diabetes and arrhythmia underwent colonoscopy on 28 August 2000, because of a positive fecal occult blood test. An elevated tumor measuring 20 mm was found in the rectum ([Fig. 1 ] a). Biopsy of three different sites revealed well differentiated adenocarcinoma.
Subsequently, on 15 September she suffered a cerebral infarction, which resulted in paralysis of the left side and aphasia. Informed consent to cancel surgery and transfer the patient to a local rehabilitation hospital was obtained from the family.
Colonoscopy was repeated on 5 December 2000 at the bedside, to re-evaluate the state of the tumor before hospital transfer. Endoscopy showed that most of the tumor had dropped off ([Fig. 1 ] b).
On 11 March 2003, a request was received from the hospital to which she had been transferred to investigate a suspected intestinal obstruction. Colonoscopic examination revealed that the partially dislodged tumor remained as a flat lesion ([Fig. 1 ] c). Impaired gastrointestinal transit was due to constipation. Repeat examination was scheduled for 6 months later.
On 11 November 2003, the tumor had increased in volume and redness, and biopsy showed well differentiated adenocarcinoma ([Fig. 1 ] d). The family declined active treatment and the clinical course was observed.
On 22 June 2004, the tumor had developed to a state approaching that observed during the first examination ([Fig. 1 ] e), but the family continued to decline surgery.
On 2 May 2005, the tumor had developed to an invasive ulcerated cancer ([Fig. 1 ] f), and multiple liver metastases were observed on abdominal computed tomography scan.
On 20 November 2005, the patient passed away, 1908 days after initial detection of the tumor.
Fig. 1 Endoscopic observation of the regrowth of colorectal carcinoma. a On 15 September 2000, an elevated tumor measuring 20 mm was found in the rectum. b On 5 December 2000, most of the tumor had dropped off. c On 11 March 2003, the partially dislodged tumor remained as a flat lesion. d On 11 November 2003, the tumor had increased in volume and redness. e On 22 June 2004, the tumor had developed to a state approaching that observed at the first examination. f On 2 May 2005, the tumor had developed to an invasive ulcerated cancer.
This was a rare case in which the process of regrowth of colorectal carcinoma was followed by endoscopic observation, after the tumor had dropped off due to the mechanical stimulation of biopsy .
- 1 Paul Jr R E, Gherardi G J, Miller H H. Autoamputation of benign and malignant colonic polyps: report of two cases. Dis Colon Rectum. 1974; 17 331-335
Y. Tomiki, MD
Department of Coloproctological Surgery
Juntendo University School of Medicine
2-1-1 Hongo Bunkyo-ku